INDICES> Atropine and Ipratopium (2)

[Helpline <helpline@thenetwork.org.pk>]

INDICES> Atropine and Ipratopium (2)
--------------------------------------------------

Dear George,

Below are abstracts of 2 studies which show the combined use of atropine and
albuterol (albuterol is synonymous with salbutamol).

1. Vichyanond P, Sladek WA, Sur S et al: Efficacy of atropine methylnitrate
alone and in combination with albuterol in children with asthma. Chest 1990;
98:637-642.
Abstract
The bronchodilator effect of atropine methylnitrate alone and in combination
with albuterol was evaluated in 16 hospitalized corticosteroid-dependent
asthmatic children (mean age 13 +/- 3 years). All patients were receiving
oral
sustained-release theophylline products and inhaled beta-agonists. Certain
patients also received other medications. The maximal bronchodilator dose
and
maximal tolerated dose of nebulized atropine and albuterol were determined
during study phase one. During phase two, the effect of maximum
bronchodilator
doses of albuterol plus atropine were evaluated. The mean maximal
bronchodilator
dose for atropine was 1.27 +/- 0.13 milligrams (0.33 +/- 0.0034 mg/kg). At
no
time was the atropine response superior to albuterol. Maximal FEV-1 achieved
after atropine was 90% of the maximum achieved after albuterol. However, the
combination resulted in bronchodilation which was prolonged greater than
with
albuterol alone throughout the 6-hour study period.

2.Diaz JE, Dubin R, Gaeta TJ et al: Efficacy of atropine sulfate in
combination
with albuterol in the treatment for acute asthma. Acad Emerg Med 1997;
4:107-113.
Abstract:
ATROPINE demonstrated no additive benefit in a well-controlled study of 153
adult patients treated in the emergency room for acute asthma exacerbations.
Status asthmaticus was an exclusion criterion. All patients received
albuterol
via nebulization, 2.5 milligrams (mg) every 30 minutes for 3 doses. As an
addition to the nebulized albuterol solution, subjects were randomly
assigned to
either saline placebo, ATROPINE (first dose only), or 2 mg ATROPINE (first
and
thirds doses only). Assessment at 90 minutes revealed no significant
differences
among the three treatment groups for any asthma efficacy parameter: peak
expiratory flow rates, vital signs, distress level, or hospital admission
rate.

Both studies give the dose of atropine used and also show that there is no
incompatibility with salbutamol or oxygen.

The recommended adult dose of atropine is 0.025 milligram/kilogram and in
children is 0.05 milligram/kilogram, diluted with 3 to 5 milliliters saline
given by nebulizer 3 or 4 times per day. In most cases, do not exceed a
total
dose of 2.5 milligrams (AHFS, 1996).

However, it is not preferred because it should be used with caution in
children
and older patients, who may be more suseptible to adverse effects. Acute
close
angle glucoma has been reported in patients recieving nebulised atropine.

Even though it is expensive, Ipratropium may be preferred because unlike
atropine inhaled ipratropium has virtually no effect on the sputum viscosity
or
volume  and does not affect the mucociliary function in the respiratory
tract.

Regards

Ayesha Ahmed
Pakistan
helpline@thenetwork.org.pk


--
Send mail for the `INDICES' conference to `indices@usa.healthnet.org'.
Mail administrative requests to `majordomo@usa.healthnet.org'.
For additional assistance, send mail to:  `owner-indices@usa.healthnet.org'.